May 19th, 2010 by AlanDappenMD in Primary Care Wednesdays
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Last week we examined how, in a typical practitioner’s day, he or she often needs to make adjustments in patients’ care to keep them on the path to getting –- or staying — healthy.
Usually a face-to-face physical exam isn’t necessary to make accurate changes to a patient’s care regiment. Instead, all discussions can be done via a form of telemedicine, such as a phone call, email, or video-conferencing. Unfortunately, it’s become standard that face-to-face time is required between patient and doctor, creating more hassle for the patient while not impacting the quality of the outcome.
I’d like to visit the case of a particular patient, Mrs. EE, and discuss how telemedicine allowed me to make small, ongoing adjustments to her medical regiment quickly and easily, and with very positive outcomes.
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April 14th, 2010 by SteveSimmonsMD in Better Health Network, Health Policy, News, Opinion, Primary Care Wednesdays
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This past Monday, I was drawn to an article in the Wall Street Journal: “Medical Schools Can’t Keep Up.” The article detailed the growing shortage of primary care doctors in our country and reminded me that we in the U.S. may have something called “insurance reform” now, but without physicians to translate insurance access into healthcare, the state of our healthcare system will continue to beg additional attention and reform.
Although new medical schools are opening and some schools have increased enrollment numbers, there are a limited number of residency positions in this country. The government has always funded these residency positions and our new reform law tries to address the primary care shortage with “slot redistribution,” whereby money from unused residency positions will be deferred to primary care or general surgery residency programs. Read more »
April 7th, 2010 by AlanDappenMD in Better Health Network, Opinion, Primary Care Wednesdays, True Stories
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In my medical practice, I have a simple yet revolutionary idea: I get paid to answer the phone. Every one of my 3,000+ patients has my cell phone and email address so that they can reach me the instant they need help, which is no different than any of my friends or family who may be trying to reach me. Our practice motto: “Talk to your doctor anytime, anyway, anywhere.”
It’s not that I’m trying to not see you, or want to be impersonal or to practice risky healthcare. In fact, each of these common assumptions is pointedly wrong. By answering my phone, I can know my diagnosis and treatment worked (or not), or I can help someone avoid an ER visit or unnecessary office visit. My patients call me when they’re traveling, or at work, or from their car, at night and on weekends. There’ve been occasions that I need to see a patient NOW and I’ve come to the office a 2AM to keep someone out of an ER. No matter what, by picking up the phone to talk to my patients, I’m the first person in the healthcare system to know something is wrong, not the last.
Although good examples supporting the power of a doctor answering a phone occur daily, I have one I want to share with you. Read more »
March 24th, 2010 by AlanDappenMD in Primary Care Wednesdays
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Many companies and consumers are turning to higher-deductible health care plans (HDHPs) in order to keep their insurance policies more affordable. The rational basis of these plans is that since you’re using your money and you are in control, you will pay more attention to what is really being offered to you as well as to the cost relative to value. You will be more likely to challenge your doctor to provide the rationale for an expensive test or drug, and to encourage your doctor to innovate to provide lower-cost alternatives.
A trap of these new health plans, as currently structured, is that you’re herded into in-network ‘preferred providers.’ The rationale of the insurance company is that they can control doctors’ prices, thus brokering a better rate for you. They also want to use your loyalty to the network to control physicians’ practices. “Preferred,” in reality, does not refer to quality; rather it just means the doctor has signed an agreement with the insurance company, binding them to the insurance company rules, which favor the insurance company, not the patient.
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February 24th, 2010 by SteveSimmonsMD in Primary Care Wednesdays
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I don’t know if I can do it this time. A month ago, when it appeared that Congress had backed out of passing Health Care Reform legislation, I felt neither happy nor sad. I didn’t know how I felt but this past Monday, after the following triad of events had unfolded, it became clear to me that I feel weary towards the whole healthcare reform process:
- First, several states temporarily halted a rapacious rise in health insurance premiums from companies with quarterly profits last year in the billions of dollars. Seriously, don’t these companies have PR firms?
- Second, the Senate Finance Committee actually issued a drug warning and in this one act illuminated either a glaring problem with Congress or – far more concerning and unfortunately for us, more likely in this instance–some type of bias at the FDA.
- Thirdly, the President called for a televised debate on health care between ‘both sides.’ Then, within days, he posted his own plan on the White House website. It is a ten page summary I found hard to follow that left me with a troubling sense of déjà-vu.
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